The Canadian Palliative Care Association has developed a definition of palliative care that reads:

"Palliative care, as a philosophy of care, is the combination of active and compassionate therapies intended to comfort and support individuals and families who are living with a life-threatening illness. During periods of illness and bereavement, palliative care strives to meet physical, psychological, social and spiritual expectations and needs, while remaining sensitive to personal, cultural and religious values, beliefs and practices. Palliative care may be combined with therapies aimed at reducing or curing the illness, or it may be the total focus of care."

The hospice system in Canada is more similar to that in the UK than to the USA's. This may be related to the support it receives from the National Health Services. A recent survey found that while 80% to 90% of Canadians think it's very important to be able to die in familiar, comfortable surroundings, 95% say they would need help from organizations such as hospice to be able to achieve this. In fact, only 10% of Canadians with advanced illness actually receive hospice palliative care. The cost of being able to stay at home when terminally ill is considerable, and the patient or the family usually has to find this money. (In the USA hospice care is usually covered by Medicare or Health Maintenance Organization (HMO) payments).

In general, the overall knowledge of hospice in Canada is poor. In another survey, only 50% of Canadians had ever heard of hospice care, and only a third of these could describe it adequately.

However, this is changing. The largest volunteer hospice organization in Canada is the Hospice Association of Ontario. It has grown from 8 to 100 member agencies in the last 10 years, and now has over 12,000 active volunteers. Basic palliative care costs are covered by the government. Other costs may be covered under private insurance plans. Other jurisdictions have their own methods of funding. It is wise to verify all insurance coverage and costs with the agency providing palliative care.

The National Health Services in Canada provide in-home nursing care (using home support workers), so that the expenses of terminal care are partially born by this system, to a limited extent. However, in August 2000 the National Leadership Roundtable on Health Reform reported that funding for health care in Canada does not reflect the necessary realities of the services needed, and that spending on physicians and hospital services leaves many other services (including end-of-life care) 'out in the cold'. Palliative care is provided in hospitals and nursing homes, but not outside, as funding is totally inadequate to supply it in the home. And the 650-odd voluntary hospice organizations in Canada are only able to ensure that 10% of dying Canadians actually receive hospice benefits.

The Vanderhoof Hospital Society of B.C. represents a typical Canadian hospice organization. There is a board of directors and a part-time paid coordinator. The coordinator is responsible for organizing the volunteers, who work in different areas including fundraising, office work, education, and, chiefly, with dying persons and their families and loved ones. After a referral to the hospice, the coordinator arranges to visit. A volunteer attends as well, and subsequently spends considerable time with the patient. This can involve reading, playing games, going on excursions, or simply sitting beside the patient - "being there".

Canadian hospice volunteers are not responsible for any personal care of the patient. This is supplied by the home support workers in the home, nursing staff in hospital, or care-aids in long term care facilities. The various organizations make little mention of special training for hospice volunteers, or of the 'project team' approach involving the patient's physician, the hospice physician, the visiting registered nurse, the nursing aid, and the volunteers.

To contact a hospice or palliative care organization in your Province, visit the Canadian Palliative Care Association